Provider Demographics
NPI:1215706015
Name:LOPEZ GONZALEZ, MIRIAM ORLEYDA (NP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ORLEYDA
Last Name:LOPEZ GONZALEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 ALDINE MAIL RTE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-3804
Mailing Address - Country:US
Mailing Address - Phone:281-598-3300
Mailing Address - Fax:
Practice Address - Street 1:5230 ALDINE MAIL RTE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3804
Practice Address - Country:US
Practice Address - Phone:281-598-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner